Chemotherapy for advanced bowel cancer

Treatment with chemotherapy is unlikely to cure advanced bowel cancer. But it may shrink the cancer and help you to live longer. Other aims of treatment are to slow the growth of the cancer and control symptoms such as pain, loss of appetite and weight loss.

For advanced cancer, the aim of chemotherapy is to help you feel better. So if you find the side effects too much, you can stop the treatment whenever you want to.

The drugs doctors use for bowel cancer that has come back after treatment or has spread are

• FOLFOX – a combination of folinic acid (leucovorin), fluorouracil and oxaliplatin given into a vein
• Capecitabine (Xeloda) tablets
• Fluorouracil (5FU) into a vein
• FOLFIRI – a combination of folinic acid (leucovorin or calcium folinate), fluorouracil and irinotecan
• Irinotecan into a vein
• Tegafur and uracil (Uftoral) capsules

The links above take you to detailed information about these treatments and their side effects. There is also detailed information about the side effects of bowel cancer chemotherapy in this section.

You may have treatment as tablets or capsules to take at home. Or you may have treatment as liquids given into a vein. Your doctor will take into account various factors when deciding which chemotherapy treatment is best for you. They will look at which treatments you have already had and how long it took for the cancer to come back. Your doctor will also discuss the treatment with you.

Treatment given when the cancer first comes back is called first line treatment. If the cancer comes back after first line treatment, or if the first line treatment does not control the cancer, you may be able to have a different chemotherapy treatment. This is called second line treatment.

Trials are continually being carried out to try and improve treatment for advanced bowel cancer. Trials may use new drugs or try different combinations of drugs. A newer drug called raltitrexed (Tomudex) is sometimes used for advanced bowel cancer. But NICE says that you should only have it as part of a clinical trial at the moment, as there is not enough evidence that it works. 

You can find information about chemotherapy trials for bowel cancer on our clinical trials database.

If you have treatment into a vein, you usually have it in the outpatient department or chemotherapy day unit. You can have the chemotherapy through a thin, short tube (a cannula) put into a vein in your arm each time you have treatment. Or you may have it through a central line, a portacath or a PICC line. These are long, plastic tubes that give the chemotherapy directly into a large vein in your chest. You have the tube put in just before your course of treatment starts and it stays in place as long as you need it.

If you have treatment with capecitabine tablets or tegafur and uracil capsules (Uftoral), you will be able to take them at home. You usually take capecitabine tablets twice a day for a few months. You usually take Uftoral with folinic acid (a vitamin), which helps it to work. You take the treatment daily for a few weeks and then have a break, before starting treatment again.

Some people prefer to have treatment with tablets or capsules because they can take them at home. Then you don't have to go to hospital so often. Capecitabine and tegafur with uracil are types of fluorouracil. But the capsules cause different side effects to fluorouracil given into a vein. The tablets or capsules are less likely to cause diarrhoea or a sore mouth. But they are more likely to cause sore, red skin on your palms and soles, which may peel.  This is known as hand and foot syndrome. 

There is information about the specific side effects of capecitabine and tegafur with uracil in our cancer drug section.

Your doctor will usually arrange a scan before you start treatment and again about 3 months later. Your doctor can measure the tumour on the scan and so will be able to see how well the treatment is working. The tumour may have

• Got smaller
• Got bigger
• Stayed the same

If the cancer has stayed the same size, your doctor will want to talk to you about whether or not it is worth carrying on with the treatment.

If it has got bigger, your doctor will stop the chemotherapy and may suggest trying a different treatment.

If it has got smaller, you may have a break and then have more treatment. According to a recent study, it may be just as helpful to have chemotherapy for 3 months for advanced bowel cancer as it is to have it for longer. You may benefit from a break. Your doctor will talk through the pros and cons with you.

Sometimes, doctors use surgery to remove bowel cancer cells that have spread to the liver (liver metastases). You can only have this treatment if there is no sign that the cancer has spread anywhere else in the body, apart from the liver. You will have a PET-CT scan to check whether there are cancer cells outside the liver.

If the liver tumour is too large to operate on, you may have FOLFOX or FOLFIRI chemotherapy to try to shrink the cancer and make it easier to remove.

If the liver tumours are small, you may have 3 FOLFOX chemotherapy treatments before and after the surgery. A recent trial showed that the chemotherapy helps people to live longer after the operation.

If your doctor believes that standard chemotherapy for advanced bowel cancer is unlikely to help you, they may offer you treatment as part of a clinical trial. Trials test new, experimental drugs being developed. If you are offered experimental treatment

• You should always be offered it as a part of a clinical trial
• All the risks and possible benefits should be clearly explained to you
• Previous research will have suggested that the drug will help bowel cancer
• The trial will help doctors to find out how much it is likely to help people in the future
• Your doctors will find out more about the side effects of the drug from the trial results

You can leave a trial at any time.  You do not have to give a reason.

For information about having chemotherapy, look at our main chemotherapy section. It explains the treatment in more detail including

• What chemotherapy involves
• How chemotherapy is planned
• How you have the treatment
• General chemotherapy side effects
• Side effects of specific drugs
• Living with chemotherapy

Our bowel cancer organisations page has details of information services you can contact for more information about bowel cancer and its treatment. There are also books and booklets available, some of which are free.